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Aim: Lithium, even at low doses, appears to offer neuroprotection against a wide variety of insults. In this controlled pilot, we examined the safety (i.e., side‐effect profile) of lithium in a sample of young people identified at ultra‐high risk (UHR) for psychosis. The secondary aim was to explore whether lithium provided a signal of clinical efficacy in reducing transition to psychosis compared with treatment as usual (TAU). Methods: Young people attending the PACE clinic at Orygen, Melbourne, were prescribed a fixed dose (450 mg) of lithium (n = 25) or received TAU (n = 78). The primary outcome examined side‐effects, with transition to psychosis, functioning and measures of psychopathology assessed as secondary outcomes. Results: Participants in both groups were functionally compromised (lithium group GAF = 56.6; monitoring group GAF = 56.9). Side‐effect assessment indicated that lithium was well‐tolerated. 64% (n = 16) of participants in the lithium group were lithium‐adherent to week 12. Few cases transitioned to psychosis across the study period; lithium group 4% (n = 1); monitoring group 7.7% (n = 6). There was no difference in time to transition to psychosis between the groups. No group differences were observed in other functioning and symptom domains, although all outcomes improved over time. Conclusions: With a side‐effect profile either comparable to, or better than UHR antipsychotic trials, lithium might be explored for further research with UHR young people. A definitive larger trial is needed to determine the efficacy of lithium in this cohort. [ABSTRACT FROM AUTHOR]

High rates of mental illness among students and discontinuation with university studies are regularly reported. The current study sought to explore relationships between motivation, university adaptation and indicators of mental health and well-being and academic performance of 184 first-year university students (73% female, mean age?=?19.3 years). As expected, intrinsic motivation was associated with greater subjective well-being, meaning in life and academic performance. Extrinsic motivations showed few relationships to outcome variables, while amotivation was consistently associated with poor outcomes. Hierarchical regression revealed that after accounting for adjustment, motivational orientations provided a small, though significant, contribution to the prediction of outcomes. These results are discussed in relation to Self-Determination Theory, the eudaimonic/hedonic dichotomy and implications for career counselling and teaching.

Viktor Frankl theorized that an absence of meaning in one's life can result in boredom and apathy—the "existential vacuum"—and attempts to avoid or "escape" the vacuum can include short-acting distracting behaviors. This study investigated whether the presence of meaning (PM) or the search for meaning are associated with alcohol, drug, and cigarette use by young adults, and whether boredom mediates those relationships. Hundred and seventy-six young adults completed the Meaning in Life Questionnaire, the Alcohol Use Disorders Identification Test, and provided information about cigarette and illicit drug use over the preceding year. The results partly support Frankl's model: higher PM was associated with lower alcohol/other drug use and boredom mediated those relationships, but PM was not related to cigarette smoking. Contrary to Frankl's model, no relationship was found between search for meaning and alcohol, drug, or cigarette use. This suggests that psychological interventions that assist individuals who use drugs or alcohol to identify meaning or purpose in their lives might reduce levels of drug and alcohol use. The process of searching for meaning may not have substantial direct impact on levels of substance use, but once some meaning was established there may be decreased impetus to continue using drugs and alcohol. [ABSTRACT FROM AUTHOR]

High rates of mental illness among students and discontinuation with university studies are regularly reported. The current study sought to explore relationships between motivation, university adaptation and indicators of mental health and well-being and academic performance of 184 first-year university students (73% female, mean age = 19.3 years). As expected, intrinsic motivation was associated with greater subjective well-being, meaning in life and academic performance. Extrinsic motivations showed few relationships to outcome variables, while amotivation was consistently associated with poor outcomes. Hierarchical regression revealed that after accounting for adjustment, motivational orientations provided a small, though significant, contribution to the prediction of outcomes. These results are discussed in relation to Self-Determination Theory, the eudaimonic/hedonic dichotomy and implications for career counselling and teaching. [ABSTRACT FROM AUTHOR]

The concept of ultra-high risk for psychosis (UHR) has been at the forefront of psychiatric research for several decades, with the ultimate goal of preventing the onset of psychotic disorder in high-risk individuals. Orygen (Melbourne, Australia) has led a range of observational and intervention studies in this clinical population. These datasets have now been integrated into the UHR 1000+ cohort, consisting of a sample of 1,245 UHR individuals with a follow-up period ranging from 1 to 16.7 years. This paper describes the cohort, presents a clinical prediction model of transition to psychosis in this cohort, and examines how predictive performance is affected by changes in UHR samples over time. We analyzed transition to psychosis using a Cox proportional hazards model. Clinical predictors for transition to psychosis were investigated in the entire cohort using multiple imputation and Rubin's rule. To assess performance drift over time, data from 1995-2016 were used for initial model fitting, and models were subsequently validated on data from 2017-2020. Over the follow-up period, 220 cases (17.7%) developed a psychotic disorder. Pooled hazard ratio (HR) estimates showed that the Comprehensive Assessment of At-Risk Mental States (CAARMS) Disorganized Speech subscale severity score (HR=1.12, 95% CI: 1.02-1.24, p=0.024), the CAARMS Unusual Thought Content subscale severity score (HR=1.13, 95% CI: 1.03-1.24, p=0.009), the Scale for the Assessment of Negative Symptoms (SANS) total score (HR=1.02, 95% CI: 1.00-1.03, p=0.022), the Social and Occupational Functioning Assessment Scale (SOFAS) score (HR=0.98, 95% CI: 0.97-1.00, p=0.036), and time between onset of symptoms and entry to UHR service (log transformed) (HR=1.10, 95% CI: 1.02-1.19, p=0.013) were predictive of transition to psychosis. UHR individuals who met the brief limited intermittent psychotic symptoms (BLIPS) criteria had a higher probability of transitioning to psychosis than those who met the attenuated psychotic symptoms (APS) criteria (HR=0.48, 95% CI: 0.32-0.73, p=0.001) and those who met the Trait risk criteria (a first-degree relative with a psychotic disorder or a schizotypal personality disorder plus a significant decrease in functioning during the previous year) (HR=0.43, 95% CI: 0.22-0.83, p=0.013). Models based on data from 1995-2016 displayed good calibration at initial model fitting, but showed a drift of 20.2-35.4% in calibration when validated on data from 2017-2020. Large-scale longitudinal data such as those from the UHR 1000+ cohort are required to develop accurate psychosis prediction models. It is critical to assess existing and future risk calculators for temporal drift, that may reduce their utility in clinical practice over time., (© 2024 World Psychiatric Association.)